A successful study by non-profit organisation Cancer Research Malaysia (CRM) has shown feasibility of mainstreaming or implementing genetic testing and genetic counselling for improved diagnosis and treatment for ovarian cancer – this makes Malaysia the first country in Asia to have access to genetic testing for faulty BRCA genes responsible for the devastating disease.
CRM’s groundbreaking study, “Mainstreaming Genetic Counselling for Genetic Testing of BRCA1 and BRCA2 in Ovarian Cancer Patients in Malaysia” or MaGIC for short, began in 2017 to determine the impact of introducing mainstreaming in specialties such as oncology to Malaysians; to date, it has granted at least 800 ovarian cancer patients across Malaysia access to much-needed genetic testing services and risk management or treatment options.
Malaysia has only 14 clinical geneticists and 9 genetic counsellors nationwide to carry out testing in a clinic, clearly insufficient to serve a nation of 32 million people. Comparatively, there are more than 5,000 genetic counsellors in the US to serve a populace of 330 million. However, building genetic counselling capacity in lower-resource settings like Malaysia is no easy feat.
For that reason, the MaGiC study was embarked upon to test a new approach to ensure genetic testing and counselling is accessible to the population.
Ovarian cancer is often called the “Silent Killer” as there are no noticeable symptoms in the early stages and there is no blood test or screening method for early detection of the disease. According to CRM, 1 in 9 Malaysian ovarian cancer patients inherit alterations in the BRCA1 or BRCA2 genes, as compared to 1 in 20 breast cancer patients and 1 in 1,000 healthy individuals.
[Women who inherit the BRCA gene alteration have a higher risk of developing breast and ovarian cancer. On the other hand, men who inherit altered BRCA1 gene have a higher risk of developing breast cancer, while those who inherit altered BRCA2 gene have a higher risk of developing breast, prostate, and pancreatic cancer.]
Through MaGIC, specialists such as gynae-oncologists and oncologists, who are the frontliners treating ovarian cancer patients, will be provided with training to introduce genetic testing to their patients. By training gynae-oncologists and oncologists to provide these new services, more patients will be informed about their genetic risk which enables better management of cancer risk and in certain cases, access to lifesaving treatment.
Dato Dr. Rushdan, a gynaecologist at a Malaysian Ministry of Health Hospital explained, “As one of the few trained surgeons that specialise in women’s cancers, we manage the treatment of many women with different types of cancers. However, prior to this study, we received little training on how to incorporate genetics in our clinics. As a hospital situated outside of Klang Valley, it was a challenge for patients to have access to this kind of service. Thanks to the MaGiC study, we are delighted to provide equitable access to precision medicine, and hope that this will lead to an improvement in survival rates of ovarian cancer patients in Malaysia.”
“Identifying BRCA mutations in ovarian cancer patients is important for their medical management and preventative measures for their relatives. However, due to the lack of genetic counsellors, clinical geneticists and awareness among clinicians, there is inadequate genetic testing in most parts of Asia,” said Yoon Sook-Yee, Principal Investigator of the MaGIC study and Genetic Counsellor at CRM.
“Mainstreaming genetic counselling will help improve access to BRCA genetic testing in Malaysia, thereby allowing us to identify individuals with higher risk of cancer as well as improve patient access to better treatment and risk management options.”
Genetic counseling service was previously only available at 4 clinics, but access has since grown to make this available in 23 hospitals nationwide. With the new services, more patients, and individuals with family history of cancer can understand their risk as well as their families’ and subsequently choose suitable cancer screening, prevention, or treatment.